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General NPI Number Information
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NPI Number | 1639987647
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Entity Type | Individual
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Provider Name | GREG SHINHO PARK DDS
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Gender | Male
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 925 W 34TH ST LOS ANGELES CA 90089
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City | LOS ANGELES
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State | CA
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Zip | 90089-0001
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Country | US
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Telephone | 213-770-6410
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 W BURNETT ST
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City | LONG BEACH
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State | CA
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Zip | 90810-3223
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Country | US
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Telephone | 213-770-6410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 110206
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License Number State | CA
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